title: A modern combat trauma.
abstract: BACKGROUND
  The world remains plagued by wars and terrorist attacks, and improvised explosive devices (IED) are the main weapons of our current enemies, causing almost two-thirds of all combat injuries. We wished to analyse the pattern of blast trauma on the modern battlefield and to compare it with combat gunshot injuries.
  
  
  METHODS
  Analysis of a consecutive series of combat trauma patients presenting to two Bulgarian combat surgical teams in Afghanistan over 11 months. Demographics, injury patterns and Injury Severity Scores (ISS) were compared between blast and gunshot-injured casualties using Fisher's Exact Test.
  
  
  RESULTS
  The blast victims had significantly higher median ISS (20.54 vs 9.23) and higher proportion of ISS>16 (60% vs 33.92%, p=0.008) than gunshot cases. They also had more frequent involvement of three or more body regions (47.22% vs 3.58%, p<0.0001). A significantly higher frequency of head (27.27% vs 3.57%), facial (20% vs 0%) and extremities injuries (85.45% vs 42.86%) and burns (12.72% vs 0%) was noted among the victims of explosion (p<0.0001). Based on clinical examination and diagnostic imaging, primary blast injury was identified in 24/55 (43.6%), secondary blast injury in 37 blast cases (67.3%), tertiary in 15 (27.3%) and quaternary blast injury (all burns) in seven (12.72%).
  
  
  CONCLUSIONS
  Our results corroborate the 'multidimensional' injury pattern of blast trauma. The complexity of the blast trauma demands a good knowledge and a special training of the military surgeons and hospital personnel before deployment.
authors.affiliation: Department of Abdominal Surgery, Military Medical Academy, Sofia, Bulgaria.
authors.forename: Georgi
authors.initials: G
authors.lastname: Popivanov
authors.forename: V M
authors.initials: VM
authors.lastname: Mutafchiyski
authors.forename: E I
authors.initials: EI
authors.lastname: Belokonski
authors.forename: A B
authors.initials: AB
authors.lastname: Parashkevov
authors.forename: G L
authors.initials: GL
authors.lastname: Koutin
mesh_terms: D000293:Adolescent; D000328:Adult; D055826:Afghan Campaign 2001-; D000368:Aged; D001753:Blast Injuries / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008887:Military Medicine; D015599:Trauma Severity Indices; D014948:Wounds, Gunshot / Q000453:epidemiology*
keywords: blast injuries; gunshot injuries; modern combat trauma